Carlisle Gaudiane Registered Nurse (RN) | Surgery Scheduler | Prior

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Medical Billing Collections Specialist

Midwest Service Bureau

Sep 2023 - Jun 2024 (10 months)

• Responsible for electronically maintaining debtors files. • Notified customers of delinquent accounts and handled payments methods. • Maintained accurate, up-to-date debtors account information. • Collected outstanding balances from debtors. • Received inbound calls. • Made outbound collection calls to debtors. • Negotiated settlements with debtors.

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Insurance Verification and Authorization Coordinator | Surgery Scheduler

Disc MD

Aug 2023 - Jun 2026 (2 years 11 months)

• Verified patient eligibility, benefits, and coverage for surgical procedures. • Managed prior authorization requests with commercial and government payers. • Coordinated scheduling between patients, physicians, facilities, and clinical staff. • Reduced delays by proactively following up on pending authorizations. • Collaborated with physicians, nurses, and case managers to ensure timely patient care.

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Medical Billing and Collections Specialist

Ag Urgent Care

Feb 2023 - Oct 2023 (9 months)

• Responsible for charge and payment entry within Electronic Health Record. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication; • Responsible for correcting, completing, and processing claims for all payer codes; • Analyze and interpret that claims are accurately sent to insurance companies; • Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports;

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Medical Billing, Insurance Verification and Authorization (Exos CRM)

West Coast Wound and Skin Care

Aug 2022 - Aug 2024 (2 years 1 month)

• Processed medical claims and conducted claim status follow-ups. • Verified insurance eligibility and benefits for patients. • Submitted authorizations and appeals to insurance carriers. • Maintained accurate documentation and tracking of authorization requests. • Improved turnaround times through consistent payer follow-up.

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Nurse II

Department of Health

Jul 2019 - Dec 2022 (3 years 6 months)

• Assigned in Temporary Treatment and Monitoring Facility for Covid19 positive. • Contact Tracing for Covid 19 Positive. • Perform swab testing. • Respond to health needs and risks of the individuals. • Evaluate health status of patients and diagnose illness conditions. • Take history of patients’ illnesses and conduct physical examination.

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Medical Assistant/Receptionist

Affinity Home Health

Oct 2017 - Nov 2017 (2 months)

• Register patients according to established protocols • Assist patients to complete all necessary forms and documentation including medical insurance • Ensure patient information is accurate including billing information • Inform patients of medical office procedures and policy • Maintain and manage patient records • Move patients through appointments as scheduled • Answer incoming calls and deal with inquiries

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Team Leader - Medical Billing Specialist

Conifer Healthcare Solution

Oct 2009 - Mar 2017 (7 years 6 months)

• Establish and maintain security of medical records to ensure patient confidentiality on an ongoing basis • Review patient records on a daily basis for accuracy, supply any missing information and ensure compliance with company policy and government regulations • Balance accounts daily, prepare financial balance sheets and submit to finance director • Generate revenue by working with patients to establish payment schedules for late accounts, following up with them as needed for continued late payments • Evaluate and select collection agencies for use in recovering delinquent accounts, determine appropriateness of suing patients and testify for medical office in court cases • Ensure office staff members are properly collecting co-pays and p

Carlisle Gaudiane

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